Comparative Evaluation of Palonosetron versus Palonosetron with Olanzapine for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Gynaecological Surgeries

Abstract

Background: One of the most frequent and upsetting side effects of general anaesthesia, especially for women having gynaecological procedures, is PONV (Postoperative Nausea and Vomiting). Even with the availability of 5-HT3 receptor antagonists like palonosetron, high-risk patients still have breakthrough PONV. Olanzapine has become a promising supplementary antiemetic due to its multimodal receptor antagonistic properties. The purpose of this study was to evaluate the effectiveness of palonosetron by itself versus palonosetron with olanzapine in preventing PONV.

Methods: Patients receiving elective gynaecological procedures under general anaesthesia participated in prospective comparative research. Participants were divided into two groups at random: Group PO received intravenous palonosetron together with oral olanzapine, while Group P received intravenous palonosetron. During the postoperative phase, the frequency and intensity of nausea and vomiting, the need for rescue antiemetics, haemodynamic parameters, patient satisfaction, and side effects were evaluated. The results of the two groups were compared using the appropriate statistical tests, with p<0.05 being regarded as statistically significant.

Results: The combination of palonosetron with olanzapine demonstrated superior efficacy in preventing PONV compared with palonosetron alone. Patients receiving combination therapy experienced fewer episodes of nausea and vomiting, reduced need for rescue antiemetics, better postoperative comfort, and significantly higher patient satisfaction. Haemodynamic parameters remained comparable between the two groups without clinically significant adverse effects.

Conclusion: The addition of olanzapine to palonosetron provides more effective prophylaxis against PONV than palonosetron alone in patients undergoing gynaecological surgeries. Combination therapy improves patient comfort, satisfaction, and postoperative recovery without compromising safety, supporting its use as part of a multimodal antiemetic strategy in high-risk surgical patients.